Purple glove syndrome: Difference between revisions
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*Uncommon skin complication of [[phenytoin]] | *Uncommon skin complication of [[phenytoin]] | ||
*Typically associated with IV infiltration of phenytoin, but poorly understood pathophysiology | *Typically associated with IV infiltration of phenytoin, but poorly understood pathophysiology | ||
*Proposed mechanisms include:<ref>Bhattacharjee P.. Early histopathologic changes in purple glove syndrome. J Cutan Pathol. 2004;31(7):513-5.</ref> | |||
** | **Chemical irritation from added propylene glycol and sodium hydroxide | ||
** | **Vasoconstriction | ||
** | **Vasculitis | ||
** | **Microthrombus formation | ||
** | **Phenytoin leakage into soft tissue with subsequent edema | ||
*Generally develops within first 24 hours after infusion, resolves within days to weeks <ref> Santoshi JA. Purple glove syndrome: a case report. Hand surgeons and physicians be aware. J Plast Reconstr Aesthet Surg. 2010;63(3):e340-2.</ref> | *Generally develops within first 24 hours after infusion, resolves within days to weeks <ref> Santoshi JA. Purple glove syndrome: a case report. Hand surgeons and physicians be aware. J Plast Reconstr Aesthet Surg. 2010;63(3):e340-2.</ref> | ||
[[File:Purple_glove_syndrome.png|thumb|]] | [[File:Purple_glove_syndrome.png|thumb|]] | ||
==Clinical Features== | ==Clinical Features== | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Simple IV fluid extravasation | |||
*[[Arterial thrombosis]] | |||
*[[Compartment syndrome]] | |||
{{SSTI DDX}} | |||
==Evaluation== | ==Evaluation== | ||
*Clinical diagnosis based on history and exam | *Clinical diagnosis based on history and exam | ||
==Management== | ==Management== | ||
*Optimal management remains unclear | *Optimal management remains unclear | ||
*Some case reports found improvement with | *Some case reports found improvement with | ||
**topical nitroglycerin | **topical [[nitroglycerin]] | ||
** brachial plexus nerve block | **brachial plexus nerve block | ||
**elevation, heat application, soft tissue massage | **elevation, heat application, soft tissue massage | ||
*Consider vascular or hand consult if digital or skin necrosis suspected | *Consider vascular or hand consult if digital or skin necrosis suspected | ||
**Anticoagulation is occasionally started (no clear evidence that it is effective) <ref>Scumpia AJ. Purple glove syndrome after intravenous phenytoin administration presenting in the emergency department. J Emerg Med. 2013;44(2):e281-3.</ref> | **Anticoagulation is occasionally started (no clear evidence that it is effective) <ref>Scumpia AJ. Purple glove syndrome after intravenous phenytoin administration presenting in the emergency department. J Emerg Med. 2013;44(2):e281-3.</ref> | ||
==Disposition== | ==Disposition== | ||
*Given possibility of severe outcomes, recommend 24 hours of observation in asymptomatic patients | *Given possibility of severe outcomes, recommend 24 hours of observation in asymptomatic patients | ||
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==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Toxicology]] [[Category:Dermatology]] | [[Category:Toxicology]] | ||
[[Category:Dermatology]] | |||
Latest revision as of 03:53, 8 March 2021
Background
- Uncommon skin complication of phenytoin
- Typically associated with IV infiltration of phenytoin, but poorly understood pathophysiology
- Proposed mechanisms include:[1]
- Chemical irritation from added propylene glycol and sodium hydroxide
- Vasoconstriction
- Vasculitis
- Microthrombus formation
- Phenytoin leakage into soft tissue with subsequent edema
- Generally develops within first 24 hours after infusion, resolves within days to weeks [2]
Clinical Features
- Peripheral edema, blistering, pain, and discoloration of the extremity receiving intravenous phenytoin
- Pulses and sensation may be diminished
- Skin necrosis may develop
Differential Diagnosis
- Simple IV fluid extravasation
- Arterial thrombosis
- Compartment syndrome
Skin and Soft Tissue Infection
- Cellulitis
- Erysipelas
- Lymphangitis
- Folliculitis
- Hidradenitis suppurativa
- Skin abscess
- Necrotizing soft tissue infections
- Mycobacterium marinum
Look-A-Likes
- Sporotrichosis
- Osteomyelitis
- Deep venous thrombosis
- Pyomyositis
- Purple glove syndrome
- Tuberculosis (tuberculous inflammation of the skin)
Evaluation
- Clinical diagnosis based on history and exam
Management
- Optimal management remains unclear
- Some case reports found improvement with
- topical nitroglycerin
- brachial plexus nerve block
- elevation, heat application, soft tissue massage
- Consider vascular or hand consult if digital or skin necrosis suspected
- Anticoagulation is occasionally started (no clear evidence that it is effective) [3]
Disposition
- Given possibility of severe outcomes, recommend 24 hours of observation in asymptomatic patients
See Also
External Links
References
- ↑ Bhattacharjee P.. Early histopathologic changes in purple glove syndrome. J Cutan Pathol. 2004;31(7):513-5.
- ↑ Santoshi JA. Purple glove syndrome: a case report. Hand surgeons and physicians be aware. J Plast Reconstr Aesthet Surg. 2010;63(3):e340-2.
- ↑ Scumpia AJ. Purple glove syndrome after intravenous phenytoin administration presenting in the emergency department. J Emerg Med. 2013;44(2):e281-3.